Yesterday, I wrote a defense on Science-Based Medicines of Dr. Harriet Hall's book review. Hall had previously written a positive review of Abigail Shriers' book Irreversible Damage. This book was about the dangers that transsexual adolescents may face if they seek medical treatment too soon or without proper guidance. Hall had approved the book but Steven Novella (N&G) and David Gorski (N&G) removed Hall's review. It was republished by Skeptic magagzine and Michael Shermer. N&G claimed that the review was not removed due to ideological impurety or social-media pushback but because Hall's review contained inaccurate statements and poor science.I posted N&Gs reply, and as I had not yet read Shriers book (I am starting it now), I reported that two prominent skeptical scientists and doctors had opposed Halls review. N&G should have not removed Halls review. However, they responded to it with their own opinion. This is the essence of free speech. I am not yet able to judge these opposing views, and may never be. However, I will continue to observe the differences in opinions.A reader pointed out that one of them was a series tweets from Jesse Singal. He writes for The Atlantic and New York Magazine, and is an expert in sociological and scientific studies of transgender transformation (see here and here). The July Spectator also features an article by him about how media distortions the little data available about transitioning's psychological effects. (The data seem to be much less than one might think based on the loud claims of transgender advocates.Singal first fired off 16 tweets to respond to N&Gs attack against Hall and Shrier. Ill reproduce these here. You can judge for yourself and explore further if you are unsure or curious. They are short and easy to read. I will reproduce them as well as the Singals Spectator piece.2/ @stevennovella & @gorskon claim that, contrary to some of the claims made by Dr. Harriet Hall (the reviewer), "A 2020 study on hormonal therapy in trans teenagers found it decreased suicide ideation and improved the quality of life." The first half is fundamentally false:https://t.co/EVLEhskzVf Jesse Singal, @jessesingal, July 1, 20214. The vast majority of other findings did not reach statistical significance. It could be a small issue. However, SBM wouldn't claim evidence of this quality if it were in the service *of* arguing against hormones or blockers. They also reference Jack Turban's pic.twitter.com/tNcVqSaUv1 Jesse Singal, July 1, 20216/After citing a study on young people who were confused about whether they were put on blockers, they write that "You cannot blind a person to whether or not they have received a gender affirming treatment." Although I doubt it, there is confusion. Jesse Singal (@jessesingal), July 1, 2021This post includes a link to the Spectator article mentioned in the following tweet. It is also discussed at the bottom.8/ Another concern for an organization that claims to be evidence-based is the repetition of flatly false activist talking points. You could be diagnosed with something in the DSM IV by simply "having a different gender identity from the one you were assigned at birth". pic.twitter.com/jk8pPjo3Cq Jesse Singal, @jessesingal July 1, 202110/ I believe that what is going on here is, in a certain degree, ideological capture. Although it's anecdotal, and Twitter nonsense, Gorski tweeting "OK Karen" to J.K. Rowling might suggest that he views this more as a matter allyship than a careful scientific evaluation. pic.twitter.com/TFxstIBIln Jesse Singal, @jessesingal, July 1, 2021The above tweet by Gorski at Rowling is clearly offensive and gratuitously vile.12/ @gorskon or @stevennovella must correct their claim that a study where the authors claimed they didn't have enough stats to measure suicide had shown lower suicidality. This is a scientific comms error. Jesse Singal (@jessesingal), July 1, 2021.14/ The last thing: Contrast the authoritative sounding way that the authors, who are not experts in the subject, summarised the evidence with how the NHS performed in a systematic review. This is reckless. Full-stop.https://t.co/fScBYZ0dxf pic.twitter.com/g5g0Ybi22C Jesse Singal, @jessesingal, July 1, 202116/ Correction: (14) The National Institute for Health and Care Excellence (NIHEC) is not the NHS! Point remains. https://t.co/1FbrNsXBcP Jesse Singal, @jessesingal July 2, 2021These tweets give the impression that N&G are firing from the hip and making unsubstantiated claims about literature that border on distortion. All of this leads to the problem that people are so divided on the issue, either because of data bias or ideological bias, it is hard to discern who to trust. Singals' article shows that he has read many of the original studies questioning whether puberty blocks are safe and whether transitioning can reduce suicide risk. Both claims are flawed, as we don't have enough data. You can read the rest and decide for yourself. Here are some quotes from Singal.The Singals article makes several points. First, while some U.S. Gender Clinics follow what we consider to be proper care for children and adolescents with gender dysphoria, others do not and none seem to match the European standards.Second, many studies that claim transition is safe, starting with the administration puberty-blocking hormonal hormones, have been criticized. In fact, there are no reliable information on the safety of these hormones. Studies that claim that transgender children have a lower risk of suicide due to transitioning are flawed. There could be other reasons for the patterns we see, such as clinics refusing to take in children with severe mental disorders.The third reason is that the mainstream media, who tend to be unreserved supporters of transitioning, refuses to report incomplete data, false assertions or problematic claims. Singal says that this is due to the ideological bias of the media on the issue. I don't doubt it.Here are some quotes from the Singals article. It's worth reading, even though it is quite long (if you have a short attention span).Let's start with the differences in American and European treatments.The Dutch Protocol, as it is commonly known, was first brought to America in 2007 by Boston Children's Hospital. Blockers and hormones can now be found in more American youth clinics. However, access to them varies by geographic location. There are important differences between the Dutch approach to youth-gender clinics in America. The Dutch clinic discourages children from transitioning to gender nonconforming behaviors and encourages parents to do so, according to Annelou de Vries, a Dutch clinician. The clinic encourages the practice of watching until puberty begins. If the GD continues, it can be taken as a sign that blockers may be the right choice. Youth with severe mental health problems, or those who lack support from their families (or both), are not eligible for physical transition. This is a reflection of the cautious approach taken by clinics. When we examine the Dutch-protocol data, we see a subset that was carefully evaluated over a long time to make sure they had gender dysphoria. Other mental health issues could also be excluded. All of them had strong family support when they started transitioning. . . . One reason why there has been steady news flow, mostly from Europe, about gender-dysphoric young people who are physically transitioning is the lack of data on their outcomes. The UK has witnessed a slow-boiling, complicated controversy at the National Health Services, which is the sole provider of youth transition services. It was the Gender Identity Development Service at London's Tavistock Clinic. Staff raised concerns about the care provided. Some claimed that children were being pushed to take hormones and blockers as a result activist pressure. A young detransitioner, who claims she was not properly assessed and had a double mastectomy that she regrets, filed complaints. The High Court ruled that it is unlikely that under-16s will be able consent to blockers or hormonal treatment. This makes it more difficult for them to access treatment. A appeal is currently underway. However, some young people will still be able to access these services with parental consent through a complicated process. Sweden has banned youth medical transition at several gender clinics, including the famous Karolinska Institute. This ban was made only in approved research studies. In June 2013, the Finnish body that advises on treatment methods for the Finnish public health system issued guidelines. These guidelines stressed the importance of thorough assessments before administering blockers or hormones. They also stated that only a few cases may be treated with blockers after careful evaluation and proper diagnostic examinations. These actions seem to be a reflection of a growing awareness that there are many holes in the research regarding youth medical transition. The UK, Sweden and Finland conducted major reviews of literature to find a shocking lack of data that supports early treatment.How media distortions dаta:Journalistically, it is important to address this issue in the fullness of their details. We should not jump to extremes in order to pretend that youth transition is not a legitimate question. This is what almost every major American media outlet has done. This trend began long before the GOP state laws were implemented, but it is only getting worse. These laws are often used to justify not asking too many questions about very unsettling areas of medical research that focuses on vulnerable populations. What are you doing? Are you one of those Trump supporters who are transphobic? This attitude is what underpins the way these stories are presented and what news gets ignored. Except for a brief mention, CNN, the New York Times, the Washington Post, and Vox have all provided near-blank coverage of the proposed bans for youth medical transition. These outlets regularly repeat activist claims that should be closely examined and sometimes defy the basic, generally accepted facts. CNN published a March news article explaining that there is no consensus on assigning sex at the birth. However, editors later made this bizarre statement. The mainstream media coverage on this topic is filled with sanctimonious claims. It states authoritatively that children in the US cannot be prescribed hormones or blockers without a thorough assessment. False. It is not true that anyone under 18 can have surgery. The worldwide increase in youth GD clinics referrals is almost entirely due to reduced stigmatization. GD (gender dysphoria), or the perception of having GD, cannot spread through adolescent networks. This is almost certainly false based on anecdotal evidence as well as any knowledge of developmental psychology. It is a myth that trans kids will feel differently later on (according to all data). Only a small percentage of trans people do not detransition. We have no data on this topic in the contexts of youth gender care in the States.This paragraph summarizes in a nutshell the things we don't know, but are told by liberal media. I won't go any further than to mention that Singal, who is not against guided and informed transitioning emphasizes our ignorance.This issue is not something most reporters have had much experience with. They approach an activist group early to discuss the issue. This organization then recommends media-friendly experts that are on the forefront of this issue, i.e. seeking to end the last vestiges of trans youth's gatekeeping. The journalist will be able to assure them that there are no valid concerns about the safety of medical treatment for young trans youth. Transphobes are people who feel otherwise. It's that simple. It's a familiar story, but it is not true. We need more data about trans youth healthcare. We don't have enough data on trans youth healthcare. This means that everyone, particularly families with children with later-onset GD, is still blind. Parents should have access to all information available that will help them understand the potential benefits, as well as the risks and unknowns associated with hormones and blockers. American journalists are trying to be on the right side in an emotionally charged and complicated issue is a misguided attempt to hinder their ability to obtain it.I am well aware of the ideological biases of liberal American journalists and I believe they are willing to believe that they don't want to be scientists. This debate will continue until there is enough data to resolve the medical issues. It seems that we are still a ways away from this.
